“Working full time and completing graduate nursing clinicals in the time of global pandemic has cast shadows of uncertainty for our country, our hospitals and our very careers. Finding willing preceptors to teach prospective advanced practice nurses while simultaneously facing the Covid-19 pandemic head-on has required a harrowing effort from students, staff and communities. I feel particularly lucky to have such a wonderful rural community that has been part of the mutual support system that has kept us all afloat in the maelstrom.”
In January of 2020, my health system began preparedness for the Covid-19 pandemic. As we began to see cases in the United States, we opened emergency operations centers in each entity and at the health system level. As a member of the senior leadership team at Johns Hopkins All Children’s Hospital, I was part of our emergency operations leadership team.
The heroes of the Covid-19 pandemic are those front line nurses and health care professionals providing care to patients.
There is an entirely different “line” that exists to support these front line team members to ensure that they have what they need to care for patients and to keep themselves safe.
We created systems for monitoring personal protective equipment and other critical supplies, developed policies and practices in response to changing national guidelines and what was happening in our community,In January of 2020, my health system began preparedness for the Covid-19 pandemic. As we began to see cases in the United States, we opened emergency operations centers in each entity and at the health system level. As a member of the senior leadership team at Johns Hopkins All Children’s Hospital, I was part of our emergency operations leadership team.
The heroes of the Covid-19 pandemic are those front line nurses and health care professionals providing care to patients.
There is an entirely different “line” that exists to support these front line team members to ensure that they have what they need to care for patients and to keep themselves safe.
We created systems for monitoring personal protective equipment and other critical supplies, developed policies and practices in response to changing national guidelines and what was happening in our community, and worked to keep our team informed. The challenges were, and are, many, including staying abreast of rapidly changing knowledge and guidelines, managing the fear that one of our team members would contract the virus and managing concern for our own and our families’ health.
The challenges ultimately have not defined the experience. Early on, we posted a meditation in the emergency operations center reminding us that we are ordinary people doing sacred work and focusing us on service, kindness and compassion. Ultimately, how our team did our work has defined the experience: The commitment and agility of our front line staff, the incredible teamwork across departments and disciplines and the relationships we developed and strengthened.
The pandemic is not over. We are still managing. We are still learning. We are a better team.
Front line — I hear that word every day. I don’t work in New York or anywhere close to a big city. I’m in rural Winamac, Indiana, a town of 2,800 people. For those people served by our small critical access hospital, we are the front line. I am the sole CRNA for this community, and my world changed the second week of March.
When Covid-19 came, we knew almost nothing. I was told there would be a webinar from the Indiana Department of Health. There were 25 health care providers in the room.
When the presentation got to intubation and how to deal with these patients, the whole room turned to look at me.
I had been asked my opinion on different clinical matters, but now I was “it” — no one else.
I have been caring for critically ill patients and doing anesthesia for over 20 years. I have seen a lot. I have clinical privileges in 18 different hospitals. Now was my moment. I helped develop policy and procedures. Set up special rooms and gathered as many supplies as I could because we weren’t going to get much outside help.
I had one ventilator, not counting my two anesthesia machines. I managed to get two more vents in a week. I have had several positive patients that have needed my services since this all started. Many middle-of-the-night calls with admissions of positive or possible positive patients. We have had some deaths. The stats are not good for patients requiring ventilation support.
The nurses who have gone to places like New York and have seen death at an unprecedented scale — they are heroes. Some have paid the ultimate price for their service. I get thanked a lot for my service, but I don’t feel like a hero.
I’m just fighting the battle in my small corner of the world against an enemy I can’t see.
While I am not on the front lines of the Covid-19 pandemic, I have a crucial responsibility to graduate nursing students so they may help on the front lines. When the pandemic hit, our students at Lord Fairfax Community College were on spring break. They were not allowed to come back to campus or to complete their clinical and preceptorship experiences.
Even so, our board of nursing and state officials were strongly encouraging nursing programs to graduate our seniors on time.
We teach our students that when there is change, we adapt. Well, change is now upon us and we are having to adapt.While I am not on the front lines of the Covid-19 pandemic, I have a crucial responsibility to graduate nursing students so they may help on the front lines. When the pandemic hit, our students at Lord Fairfax Community College were on spring break. They were not allowed to come back to campus or to complete their clinical and preceptorship experiences.
Classes were quickly converted online with Zoom classrooms. Over many hours and through creativity and perseverance, we were able to see that all 78 students graduated. All are now working as RNA’s (Registered Nurse Applicants) and preparing to take their boards.
I manage over 160 nurses, many of whom are also Auburn alumni. When the Covid-19 pandemic started, I was responsible for making sure my staff was up to date daily, sometimes hourly, on changes with proper PPE usage, plan for conservation, plan of care for pediatric patients, aerosolized treatments and more.
Our number one goal has always been to care for our patients. Staff were understandably scared and frustrated with the situation, especially unprecedented shortages in supplies. I worked at many as 14 days straight to make sure my staff was educated and comfortable, so they were able to provide care to our patients
As time went on and the number of pediatric cases didn’t hit the high as expected, we had another new challenge — budget.I manage over 160 nurses, many of whom are also Auburn alumni. When the Covid-19 pandemic started, I was responsible for making sure my staff was up to date daily, sometimes hourly, on changes with proper PPE usage, plan for conservation, plan of care for pediatric patients, aerosolized treatments and more.
Our number one goal has always been to care for our patients. Staff were understandably scared and frustrated with the situation, especially unprecedented shortages in supplies. I worked at many as 14 days straight to make sure my staff was educated and comfortable, so they were able to provide care to our patients.
As time went on and the number of pediatric cases didn’t hit the high as expected, we had another new challenge — budget.
I was responsible for making sure I was utilizing all my resources appropriately and using the right amount of staff. At one point, I was having to cancel as many as 13 nurses per shift. I was able to get creative and offer split shifts, extra PTO and allowed several of my staff to come off the schedule to work in areas that had higher needs, such as New York.
As we entered May and began to open up, I looked back at my staff and all they were able to accomplish. I am proud of them and I am proud of the leadership skills I earned at Auburn that have enabled me to lead my team through this pandemic.
As a research nurse, I am honored to be part of several Covid-19 research studies, including the Remdesivir treatment study. In March, our team went from working at home to quickly starting an inpatient study, which included not only completing all the trainings in record time, but also coordinating with the many areas and staff within the hospital. I know we all have hopes that one of these vaccines will be successful.
Soon our team will also be honored to start working on several more studies, including the Moderna vaccine study.
These studies have required me to put in long hours, which have been hard due to the intensity, along with the mental and physical exhaustion. My work has affected my two teenagers and my current Auburn student, as I am a single mom. Many days, I have come home, taken a shower and crawled into bed. My children have risen to the occasion to assist with preparing meals, picking up groceries and cleaning the house. They feel they are contributing to Covid-19 research by supporting me. I am proud of them and again honored to be part of this research, which gives me much hope for the future. I know working together is the only way we will defeat this virus.
As a former ICU nurse and currently serving as the system director of value analysis in supply chain, I feel a strong connection and responsibility to the safety of the caregiver and patient. On a daily basis my goal is to ensure our clinicians have the supplies they need to care for our patients in a safe, efficient and cost-effective capacity. During the Covid-19 surge, this goal became particularly meaningful with PPE shortages, constantly changing guidance, price gouging and overall uncertainty of the situation.
My team of five nurse value analysis managers and I developed degradation plans for every type of critical PPE and supply.
With these plans, we answered tough questions like: If we run out of health care N95 masks or level 2 isolation gowns, what do we use next?
What alternatives are available if we run out of IV tubing? What alternative cleaning solutions will kill Covid and not ruin our equipment? How do we operationalize and communicate all these changes?
We worked very closely with our supply chain operations partners to determine stock on hand and burn rates to predict if and when supply would run out. Unfortunately, it became clear that we would run out of PPE unless we implemented additional processes to ration, conserve and, where appropriate, reuse supplies. UV light, reprocessing and PPE stations were set up at every facility to disinfect, collect, redeploy and limit waste.
Given the state of constantly changing guidance and the need to conserve, my team and I rounded in each facility daily and aligned ourselves with the senior leadership team, infection prevention and regional incident command centers. We built triage protocols for supply donations that were pouring in from the community. We quickly assessed the viability of the supplies in a clinical environment: Is the procedure mask ASTM rated? Is the gown AAMI rated? Is it a health care N95 or industrial N95 mask? Are staff fit tested for that particular N95 mask brand? Is the product expired? Depending on our assessment, we determined if the donation was suitable for immediate use, to be held as part of our contingency plan or not suitable for use. In addition, my team partnered with our purchasing/sourcing department to assess various supplies being offered as a spot-buy through non-traditional networks. We assessed the supply on clinical appropriateness, cost, lead time, amount available and legitimacy of the vendor.
“I am a public health nurse practitioner. While this is a challenging time in my career, it is also rewarding. Auburn not only taught me well, but gave me the toughness to do my job.”
